International guidelines recommend physical activity for subjects with nonalcoholic fatty liver disease (NAFLD). This study investigated the association of physical activity with risk of liver fibrosis, sarcopenia, and cardiovascular disease (CVD) in NAFLD.
In this multicenter, retrospective study, 11,690 NAFLD subjects who underwent a health screening program and were assessed for physical activity (metabolic equivalent task [MET]-min/week) between 2014 and 2020 were recruited. Liver fibrosis was assessed using the fibrosis-4 index, NAFLD fibrosis score, and FibroScan-AST score. Sarcopenia using multi-frequency bioelectric impedance analysis and CVD risk using atherosclerotic CVD (ASCVD) risk score and coronary artery calcium (CAC) score were calculated.
The prevalence of fibrosis, sarcopenia, high probability of ASCVD, and high CAC score significantly decreased with increasing quartiles of physical activity (all P for trend<0.001). In a fully-adjusted model, physical activity above 600 MET-min/week (≥3rd quartile) was independently associated with a reduced risk of fibrosis (adjusted odds ratio [aOR]=0.59; 95% CI=0.40–0.86), sarcopenia (aOR=0.72; 95% CI=0.58–0.88), high probability of ASCVD (aOR=0.58; 95% CI=0.46–0.73), and high CAC score (aOR=0.32; 95% CI=0.13–0.83; all P<0.05). Additionally, increasing amounts of physical activity was significantly associated with a risk reduction between fibrosis, sarcopenia, and high probability of ASCVD (all P for trend<0.001). In subjects with sarcopenic obesity or lean NAFLD, physical activity was also independently associated with a reduced risk of fibrosis and high probability of ASCVD (all P<0.05).
Physical activity showed a protective effect against fibrosis, sarcopenia, and CVD in NAFLD.
Keywords : Nonalcoholic fatty liver disease, physical activity, liver fibrosis, sarcopenia, cardiovascular disease